MEDICARE: THE DERMATOLOGY CENTER,PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	01046423	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033142773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DERMATOLOGY CENTER,PSC

Provider Business Mailing Address
First Line	:	825 UNIVERSITY WOODS DR
Second Line	:	SUITE 8
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2427
Country	:	US
Telephone Number	:	812-944-7500
Fax Number	:	812-944-4656

Provider Business Practice Location Address
First Line	:	825 UNIVERSITY WOODS DR
Second Line	:	SUITE 8
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2427
Country	:	US
Telephone Number	:	812-944-7500
Fax Number	:	812-944-4656

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DUANE EDWARD BANET
Credential	:	M.D.
Telephone Number	:	812-944-7500

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	11/04/2015

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Directions to “THE DERMATOLOGY CENTER,PSC ” Practice Location

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